Clinical ophthalmology (Auckland, N.Z.)最新文献

Purpose: To describe the intraoperative Flutter Sign as a real-time indicator of anterior hyaloid face (AHF) integrity following posterior capsule tear (PCT) during phacoemulsification.

Design: Single-centre observational study combining retrospective review of twelve intraoperative PCT cases with prospective evaluation of eight additional cases. Retrospective observations guided structured assessment in the prospective arm, focusing on PCT edge behaviour and AHF integrity.

Methods: Surgical videos of twelve eyes with intraoperative PCT were analysed for tear edge morphology and motility. Based on these findings, eight prospectively observed PCT cases were examined intraoperatively for edge behaviour and AHF status. Additional parameters included need for vitreous surgery, type of intraocular lens (IOL) implanted, and intraoperative and postoperative complications associated with PCT.

Results: Eleven eyes demonstrated sharp, fluttering PCT edges with intact AHF, no vitreous prolapse, and no need for anterior vitrectomy. Of these, five received in-the-bag IOLs, while six underwent sulcus fixation. All achieved a best corrected visual acuity (BCVA) of 20/20. Nine eyes exhibited scalloped, non-fluttering edges, consistent with AHF rupture and vitreous prolapse. All required anterior vitrectomy and sulcus-fixated IOLs. Three patients in this group experienced posterior migration of lens material: two had small cortical or nuclear fragments that were clinically insignificant and required no intervention, while one patient had a large nuclear fragment that necessitated a secondary procedure for removal. BCVA was reduced in two eyes to 20/30. Two patients experienced transient elevation of intraocular pressure. No cases of retinal detachment or endophthalmitis were observed.

Conclusion: The Flutter Sign is a simple, dye-free, real-time indicator of AHF integrity after PCT, with fluttering edges signifying intact AHF and scalloped static edges indicating vitreous prolapse.

Purpose: We evaluated the ability of ChatGPT, an Artificial Intelligence (AI) Chatbot, to respond to patient eye health queries.

Methods: A retrospective, cross-sectional analysis of eye health questions and physician responses posted on the American Academy of Ophthalmology (AAO) "Ask an Ophthalmologist" forum was performed on a random sample from January 2016 to December 2022. We compared board-certified ophthalmologists' responses to ChatGPT (version GPT-4o, OpenAI) responses in September 2024. Primary outcomes included ophthalmologist-rated accuracy of ChatGPT and AAO responses using a 7-point Likert scale, as well as ophthalmologists' preferences between the two responses. Secondary outcomes assessed differences in readability, empathy, and response length between ChatGPT and ophthalmologists.

Results: A random sample 250 questions and responses from 41 board-certified ophthalmologists were evaluated. ChatGPT and AAO responses had similar mean accuracy ratings (5.8 [SD=1.1] vs 5.5 [SD=1.1], p=0.07). Evaluators preferred ChatGPT over physician responses in half (49.5%) the cases. Ophthalmologist responses were easier to understand, with a lower mean Flesch-Kincaid Grade Level (Grade 11.0 [SD=2.7] vs Grade 12.7 [SD=1.9], p<0.001). Ophthalmologist responses were also significantly shorter than ChatGPT responses (80.6 [SD=56.4] words vs (337.8 [SD=141.6] words, p<0.001). Empathy ratings did not differ significantly between ChatGPT and ophthalmologists (4.4 [SD=0.6] vs 4.4 [SD=0.6], p=0.5).

Conclusion: Our findings suggest that Chatbot responses were as frequently preferred as physician responses, rated with higher accuracy, and demonstrated comparable empathy in addressing online patient eye health queries. AI chatbots may assist in drafting initial responses to patient concerns, potentially improving efficiency and reducing physician workload.

Purpose: To evaluate ocular health status, vision-related quality of life, and access to eye care services among a multi-ethnic refugee population in the Greater Toronto Area (GTA).

Methods: Participants completed a structured survey capturing demographic, medical, and vision-related data. Descriptive statistics were employed to summarize and interpret the responses. Canadian population data were sourced from Statistics Canada and National Vision Health Reports. Participants were recruited during ophthalmic screening outreach visits at four refugee housing sites in the GTA, and were eligible if they were adults or mature minors residing in refugee homes after arriving in Canada as refugees or asylum seekers between October 2022 and October 2024. Proportions were converted to estimated counts for comparison, and harmonized categorical variables were analyzed using Pearson's Chi-Square or Fisher's Exact Test. Bivariate and multivariate logistic regression models were then used to assess associations between demographic, clinical, and psychosocial factors and two outcomes: difficulty coping with life due to vision and history of barriers to eye care.

Results: Among 94 refugee participants (mean age 46.5 years; 41% female), rates of recent eye exams (19.1%) and prescription glasses use (51.1%) were significantly lower than in the Canadian population (74.5% and 81.0%, respectively; p<0.0001). Over half (55.3%) were dissatisfied with their vision, and financial barriers (50%) were the most reported obstacle to care. Prior abuse was associated with greater odds of encountering barriers (OR=7.65, p=0.005), while dissatisfaction with vision (OR=0.11, p=0.025) and interference with daily activities (OR=233.0, p<0.0001) strongly predicted difficulty coping.

Conclusion: Refugees face significant vision-related health disparities. Interventions should address access, government benefits, education, and psychosocial supports.

Purpose: To assess the visual and anatomical outcomes of retinopathy of prematurity (ROP) after treatment with laser therapy versus intravitreal anti-vascular endothelial growth factor (anti-VEGF) in real-world practice.

Methods: This retrospective cohort study included preterm infants with treatment-requiring ROP that underwent either laser indirect ophthalmoscopy (LIO) or intravitreal anti-VEGF therapy at Ramathibodi Hospital from January 2012 to October 2023.

Results: This study included 52 patients (104 eyes). The anti-VEGF (18 patients: 36 eyes) and LIO (34 patients: 68 eyes) groups had comparable baseline characteristics, including mean gestational age (25.80±2.81 vs 25.89±3.84 weeks; p=0.906), birth weight (693.0±34.30 vs 784.5±45.57 g; p=0.170), and mean follow-up duration (4.12±0.59 vs 4.91±0.57 years; p=0.361). Treatment occurred significantly earlier in the anti-VEGF group (postmenstrual age 33.94±0.53 vs 36.30±0.55 weeks; p=0.006). The anti-VEGF group required more follow-up visits from the initial exam until the complete regression of ROP (20.03±10.00 vs 11.80±6.03; p<0.001). The mean final visual acuity (VA) was similar between the anti-VEGF and LIO groups (logMAR 0.490 vs 0.480; p=0.852), although Zone I eyes treated with anti-VEGF tended to have better VA. Among Zone I eyes, those treated with anti-VEGF had significantly less myopia (mean spherical equivalent: -0.60 vs -12.30 D; p=0.007). Only the anti-VEGF group underwent secondary treatment, mainly for persistent avascular retina (44.4% vs 0%; p<0.001), and had treatment failure (16.7% vs 0%; p=0.002).

Conclusion: Both anti-VEGF and laser therapy demonstrated nonsignificant difference in functional and anatomical outcomes in treatment-requiring ROP. Notably, Zone I eyes treated with anti-VEGF exhibited significantly less myopia versus those treated with LIO. However, the anti-VEGF group required significantly more hospital visits and secondary treatments.

Occupational eye injuries (OEIs) remain a major public health issue despite regulatory efforts toward increasing protective eyewear use. OEIs encompass a wide spectrum of trauma, from superficial injury to tissue melt and globe rupture. These injuries are associated with substantial medical, economic, and social burden. This narrative review identifies risk factors associated with OEIs, differences based on workplace, and barriers to OEI prevention. Risks for OEI include male sex, low educational attainment, low income, or being a temporary or migrant worker. Certain industries such as metalworking, construction and manufacturing, chemical handling, and agriculture, also carry unique ocular hazards that predispose workers to OEIs. Although many OEIs are minor, those that cause severe injury can result in permanent visual loss and blindness. Industrial and construction workers are frequently exposed to high-velocity foreign bodies (FBs) and blunt trauma, while agricultural workers are at elevated risk for open globe injuries, FBs and the vision-threatening sequalae of infection from organic material. Chemical injuries, although less common, are notable for high rates of bilateral eye involvement, often requiring urgent intervention. Unfortunately, most OEIs occur in the absence of proper protective eyewear. Barriers range from discomfort and poor fit, inadequate access, and lack of perceived need, all of which contribute to low compliance in various occupational settings. Current evaluations of behavioral and regulatory interventions to increase adherence show promise but with mixed results. Advances in protective eyewear technology that optimize comfort and usage tracking may be helpful for employers to ensure compliance. A comprehensive understanding of OEI mechanisms and the obstacles to increased protective eyewear use is critical to mitigate the impact of OEIs on workers.

Purpose: To compare endothelial graft outcomes after DSAEK using pre-cut tissue and surgeon cut tissue in terms of final visual outcome and graft failure at 6 and 12 months postoperatively.

Patients and methods: This retrospective study examined patients who underwent DSAEK with CB or surgeon-prepared tissue for any etiology of endothelial dysfunction. Best-corrected visual acuity (BCVA), corneal thickness, endothelial cell count (ECC), and complications were examined before and throughout the 1-year postoperative period.

Results: Total number of cases is 98 eyes of 98 patients. Fifty-five surgeon-cut grafts were compared to 43 precut grafts. Preoperative visual acuity was >/= 20/60 in 1.8% and 0.0%, >20/60-20/200 in 21.8% and 7%, and less than 20/200 in 74.6% and 86.1% for surgeon cut and precut group respectively. Visual acuity at last follow-up was >/= 20/60 in 32.4% and 5.3%, >20/60-20/200 in 29.7% and 10.5%, and less than 20/200 in 37.8% and 84.2% for surgeon cut and precut group, respectively. At 6 months, 41 (83.7%) in the surgeon cut group and 27 (67.5%) in the precut groups completed the follow-up. Of these, 10 (24.4%) and 14 (32.6%) respectively, ended up with graft failure. The statistically significant difference in graft failure was maintained until 12 months: 37 (82.2%) in the surgeon cut group and 20 (58.8%) in the pre-cut group completed the follow-up. Of these, 11 (29.7%) and 14 (70%) labeled as failed grafts, respectively.

Conclusion: We found a higher rate of graft failure 6 to 12 months postoperatively in precut tissue grafts than in surgeon cut tissue grafts despite both tissues being provided by the same eye banks.

Purpose: To evaluate the outcomes of lensectomy with and without intraocular lens (IOL) implantation in patients with Marfan syndrome and ectopia lentis.

Methods: This retrospective review included 55 patients (85 eyes) diagnosed with Marfan syndrome who underwent lens surgery at King Khaled Eye Specialist Hospital between 2014 and 2023. Preoperative lens status; surgical technique; use of capsular support devices and IOLs; and postoperative clinical, biometric, and refractive parameters were analyzed. The primary outcome was final best-corrected visual acuity. Secondary outcomes included refractive correction (spherical equivalent), axial length, intraocular pressure, IOL position and stability, and incidence of postoperative complications.

Results: All eyes had subluxated crystalline lenses [predominantly inferotemporal lenses (52.9%)]. Surgical procedures included lensectomy with anterior vitrectomy (49.4%), lensectomy with IOL implantation (38.8%), pars plana vitrectomy with lensectomy (7.1%), and phacoemulsification with IOL (4.7%). Capsular support devices were used in 12 eyes. Secondary IOL implantation was performed in 12 eyes, with 91.7% scleral-fixated IOLs. At the final follow-up, 41.2% of the eyes were aphakic, 32.9% had scleral-fixated IOLs, 15.3% had posterior chamber IOLs, and 8.2% had anterior chamber IOLs. There was a significant association between phakic status and refractive correction (P<0.001). The final mean visual acuity improved significantly from 1.1±0.7 logMAR (20/250) at presentation to 0.3±0.3 logMAR (20/40) at the last visit (P<0.001). The IOL position was stable in 47.1% of the eyes and was significantly associated with IOL type (P<0.001).

Conclusion: Lensectomy, with or without IOL implantation, is an effective and versatile approach for managing ectopia lentis in Marfan syndrome, with favorable long-term visual and anatomical outcomes. These findings emphasize the need for individualized planning based on subluxation severity and capsular support. Improved IOL stability and vision support the use of tailored techniques. Future studies should assess long-term safety and quality of life to guide standardized care.